高血压性基底节区脑出血的三种不同治疗方案预后分析

Analysis on the prognoses of various therapeutic approaches for patients with hypertensive ganglionic hemorrhage

目的通过对高血压性基底节区脑出血患者不同治疗方案预后分析,探讨微创术治疗本病的最佳治疗方案。方法收集119例高血压性基底节区脑出血住院患者的出血量和GCS评分等临床资料,根据其治疗方案分为保守、开颅、微创3组,以第30天SSS评分为预后指标。采用SPSS10.0软件,分析不同出血量、GCS评分水平的患者预后与3种治疗方案的关系。结果多因素分析显示,出血量、GCS评分和保守治疗为患者预后的独立影响因素。出血量25.0~39.9mL各组患者预后差异无统计学意义,出血量40.0mL^90.0mL微创组和开颅组患者预后优于保守组。出血量25.0~90.0mL、GCS评分≤7分开颅组患者预后优于保守组,微创组与保守组患者预后比较差异无统计学意义;GCS评分≥8分者微创组患者预后优于保守组,开颅组和保守组比较差异无统计学意义。结论高血压性基底节区脑出血,出血量40.0~90.0mL、GCS评分≥8分的患者最适合于行微创术,GCS评分≤7分患者适合开颅手术。

Objective To explore the optimal therapeutic approaches for patients with hypertensive ganglionic hemorrhage via the prognoses of various treatment groups. Methods Of the inpatients with hypertensive ganglionic hemorrhage, 119 cases were enrolled into our studies and were divided into three groups corresponding to their managements. For each case, general data, radiological and laboratory results were documented according to their case histories, and clinical global outcome were rated in light of the Scandinavia Stroke Scale. The relationship of the prognoses of inpatients with various levels of hemotoma volume and GCS score to three kinds of therapeutic approaches were analyzed with SPSS 10.0 software. Results Multiple linear regression analysis showed hemotoma volume, GCS score and conservative treatment were independent significant factors of their prognoses. There is no statistically significant difference in the prognoses among the three treatment groups with hematomas of 25.0 - 39.9 mL. The prognoses of aspiration and craniotomy groups was superior to that of the conservative one with the hematomas of 40. 0 - 90. 0 mL. For the hematomas of 25.0 - 90.0 mL and GCS score≥8 points,the prognoses of aspiration group was superior to that of the conservative one, but there is no significant difference between the craniotomy and conservative groups. For the hematomas of 25.0 - 90. 0 mL and GCS score ≤ 7 points, the prognoses of the craniotomy group was superior to that of the conservative one, but there was no significant difference between the aspiration and conservative groups. Conclusions The patients with hypertensive intracerebral ganglionic hematomas of 40. 0 -90. 0 mL is suitable to the mini-invasive aspiration for GCS score ≥8 points and is adaptive to craniotomy for GCS score ≤7 points.